Understanding the Autism Spectrum
Counselor Toolbox for Mental Health...

 
 
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407 -Understanding the Autism Spectrum

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Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LPC
Executive Director, AllCEUs
Host: Counselor Toolbox Podcast
Objectives

– It is called a “spectrum” disorder because people with ASD can have a range of symptoms
Symptoms
– Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
– Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
– Direct communication
– Honesty
– Nonjudgmental listening
– Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
– They often think in pictures or video

Symptoms
– Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
– Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in  sharing imaginative play or in making friends; to absence of interest in peers.
– Less concern for what others may think of them can make them more independent thinkers
– Difficulty recognizing and processing the feelings of others, “mind-blindness” which may result in the inability to identify if another person’s behaviors are intentional or unintentional which can cause others to believe that the individual with autism does not have empathy or understand them. OR
– A fantastic ability to “read” people (Fiona and Sherlock “Elementary”)

Symptoms
– Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
– Stereotyped or repetitive motor movements, use of objects, or speech (hand-flapping, rocking, jumping and twirling, arranging and rearranging objects and repeating sounds, words or phrases. Sometimes the repetitive behavior is self-stimulating, such as wiggling fingers in front of the eyes)
– Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
– Some individuals pay attention to minor details, but fail to see how these details fit into a bigger picture.
– Others have difficulty with complex thinking that requires holding more than one train of thought simultaneously
– Others have difficulty maintaining their attention or organizing their thoughts and actions.

Symptoms
– Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
– Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
– Attention to detail
– Often highly skilled in a particular area
– Deep studying resulting in encyclopedic knowledge
– Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Vs. OCD
– Symptoms
– Obsessions (Thoughts)
– Compulsions (Repetitive Behaviors) in response to the obsessive thought
– But a person with OCD generally:
– Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
– Spends at least 1 hour a day on these thoughts or behaviors
– Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
– Experiences significant problems in their daily life due to these thoughts or behaviors
– Has no other symptoms of ASDs
– Medications that are effective in people with OCD include some “tricyclic” antidepressants, and several newer “selective serotonin reuptake inhibitors” SSRIs.

Frequent Co-Occurring Issues
– Epilepsy ~30% of people with autism
– Grand mal or absence seizures cause the person with ASD to blank out or stare into space for a few seconds are often triggered by
– Hyperventilation
– Malfunctioning fluorescent lights
– Intense strobe lights like visual fire alarms.
– Natural light, such as sunlight, especially when shimmering off water, flickering through trees or through the slats of Venetian blinds.
– Certain visual patterns, especially stripes of contrasting colors.
– Gastrointestinal problems – 46-85%
– Pain caused by GI issues is sometimes recognized because of a change in a child’s behavior, such as an increase in self-soothing behaviors like rocking or outbursts of aggression or self-injury

Frequent Co-Occurring Issues
– Feeding
– Sleep disturbances
– Attention-deficit/hyperactivity disorder (20%)
– Anxiety (30%)
– Depression
– Obsessive compulsive disorder

– Children with ASD do not develop a perception of themselves as active agents that can deal with novel, incongruent disorganizing information.
– They do not experience their capacity for emotion mediation.
– Social impairments in children with ASD interfere with the ability for parents to be responsive/sensitive.
– Lack of responsive parenting impairs parents ability to provide timely and responsive support which could provide a safe route to exploration and growth.
– Children with autism are attached to their parents. However, the way they express this attachment can be unusual. To parents, it may seem as if their child is disconnected. Both children and adults with autism also tend to have difficulty interpreting what others are thinking and feeling.

– Children with ASD form generalized expectations that engaging in novel situations will have catastrophic consequences, in contrast to the autonomous, growth-seeking efforts of their neuro-typical peers
– Parents of children with ASD spend considerable energy just obtaining their child’s attention which distracts from energy used to enhance their interactions
– Parents of children with ASD must employ more ‘high-intensity’ and directive methods, such as increased physical contact, as well as providing more cues and prompts
– By toddlerhood, most children with ASD have switched from passivity to more active avoidance and emotional disengagement.
– “negative mutual influence cycle” in which both parents and infants are unwittingly propelled to respond to one another in increasingly abnormal ways that dramatically impact their subsequent relationship

– Impact of parent-child relationship disruption
– Reduced exposure to parental guides who are can provide growth-promoting opportunities, tailored to their child’s uniqueness and use gradual scaffolding to increase the degrees of exposure to the unpredictability & stress in real-world.
– Reduced exposure to the hours of guided practice with parents that prepare them to successfully navigate interpersonal relationships and learn skills, values, habits, mindsets & thought processes of their more experienced guides.
– Reduced exposure to conversations with parents which enable them to identify and communicate their experiences and come to understand & value their themselves and their internal world, as well as that of others.
– Reduced exposure to a relationship which becomes increasingly internalized, so that through their own internal dialogues, they can autonomously pursue mental & self-growth.

Interventions
– Be consistent
– Stick to a schedule
– Reward good behavior
– Use teachable moments
– Create a safety zone with visual cues
– Pay attention to the kinds of sounds they make, their facial expressions, and the gestures they use when they’re tired, hungry, or want something
– Remember that behavior is a way of communicating. Find the motivation behind the behavior
– Make time for fun
– Pay attention to sensory over- or under- sensitivities and their impact on behaviors
Interventions
– Teach tasks in small steps using visual cues
– Seek respite care
– Explore individual, marriage or family counseling
– Keep a daily log using text and/or pictures
– Break large tasks (clean your room) down into smaller tasks
– Teach interpersonal interactions through cartooning
– Help the child communicate by using drawing
– Use the term challenges instead of weaknesses
– Explain the diagnosis to the patient

Examples of Autism in the Media
– Rain Man
– What’s Eating Gilbert Grape
– Fly Away
– Atypical
– Temple Grandin
– Sonya Cross “The Bridge”
– The Closer “You are Here”
– Sherlock “Elementary”
– Temperance Brennan “Bones”
Summary
Resources
– 100 Day Kit for Families
– Age appropriate autism materials
– Building Our Future: Educating Students on the Autism Spectrum
– Autism Information for Social Workers and Counselors
– Supporting Appropriate Behavior in Students with Asperger’s
– Next Steps: A Guide For Families New To Autism
– Puberty and Children on the Autism Spectrum
– Transition-Preparing_for_a_Lifetime
– Growing Up Together (For School-Aged Peers)
– Growing Up Together (For Middle School-Aged Peers)